Big Thinking; Local Planning March Symposia Outcomes Summary

This summary covers the key themes from the symposia which along with all the feedback provided will inform the development of a regional plan for mental health, suicide prevention and alcohol and other drug services in the North Brisbane and Moreton Bay region.

Acknowledging that not everyone could be in the room on the day, the PHN will continue to engage broadly with the sector, to gather feedback in tandem with this ongoing symposia series.

Testing the vision: features of a system that works for me

Following 12 months of consultation with the sector, we proposed a vision of what an integrated and effective system should look and feel like for consumers which is available in the document library. The first part of the symposia focused on testing the features of this proposed system.

Generally, participants agreed that the features identified were important, but that the way in which they were expressed needed further work, and additional features were suggested.

From discussions on the day, we also identified an additional feature, ‘A system that drives health creation to keep people healthy in their communities’ which was included for further discussion during the Symposia.

The feedback from this session was broad, but included the following suggestions:

• consider the consumer and community view of the system and reorient the features from their viewpoint – ‘People should be the drivers not just the focus’ and ‘Features of a community that works for me’.
• include early intervention and the need for preventative services
• ensure ‘Accessible for all’ empowers people to seek help - ‘empowered to access services without judgement’
• ensure ‘Health creation’ includes health promotion and stigma reduction, which are vital to enabling access
• consider better articulation of ‘No wrong door’ to ensure a move beyond silos
• include the importance of safe and secure relationships, access to housing and other social determinants across the features
• reframe ‘evidence based’ to ‘evidence informed’ to drive opportunity for innovation
• include informed consent and ensure it is consumer driven
• extend integration to reach beyond the health and community services to include education, business and private sectors and encourage collaboration not competition
• revise ‘focused on outcomes’ to define outcomes by the person, not for the person
• include the concepts of recovery and define personal recovery versus clinical recovery
• recognise and address the power imbalance between services and consumers.

The vision and features will be revised based the feedback received and we will seek ongoing input from participants and the broader sector on this revised vision over the coming months.

What needs to change to achieve this vision

In the afternoon session, participants were asked to consider what needs to change in relation to each of the features so we can achieve an integrated and coordinated mental health, suicide prevention and alcohol and other drugs health system in our region.

A summary of the key themes was presented back to the group on the day, and has been compiled below:

A system where people are the focus

• shift from ‘people focused’ to ‘people led’, system change should be driven by consumer experience - ‘A system where people are the leaders, not just the focus.’
• development of shared language driven by the community’s language. Reducing the medical language used and decreasing stigma. Changing the story from disaster to hope.
• a consumer led storytelling tool to allow people to only have to tell their story once and then control who has access to their story based on their needs, values and goals
• changing what and how we measure the delivery of services, to focus on what is important and valued by consumers, not necessary governments or funders. Shifting from outputs to outcomes, as defined by consumers and community
• a support system for the workforce and broader community to allow them to be people-focused. Training and funding models which address this.

A system that is accessible for all whatever their circumstances

• services must be built around what people choose is best for them, including a range of delivery modes and models and must be available 24/7.
• a strong focus on one-stop-shops within neutral community-based services. Also mindful that these hubs do not become too generalist, and enable services to meet needs
• structural change with funding models and a shift to flexible funding models that allow for funding to best suit the person or needs. Recognition and value placed on the engagement between consumers and service providers
• shift in paradigm – health creation (health and wellbeing) and changes in the language used i.e. focus on health and wellbeing which will help reduce stigma and discrimination.

A system that enables providers to understand people’s needs holistically

• clearly define ‘holistically’ to include all aspects of life and health including physical health, housing, family, social, emotional wellbeing, community connection as well as mental health
• the role of support people needs to be recognised and included in the care. This includes family or natural supports as well as peer workers and volunteers. Support, training and recognition of these roles is required
• funding of services needs to be holistic to enable holistic service delivery. Cannot fund silos and expect to deliver holistic services. Move away from funding ‘symptomology’ and addressing the primary cause not the result
• services need to be able to adapt to a person’s priorities and choices. If we really want a consumer driven model, we need to enable services to deliver consumer choices
• provide mental health training and literacy to other professionals, including teachers and community groups
• after hours supports are required.

A system that integrates and interacts with the broader health and community services sector

• development of systems that enable easy sharing of information. Allowing consumers to control who they share their story with in an effective and efficient way. Ensuring appropriate guidance and policies exist which protect privacy and confidentially whilst recnognising the benefits of shared care
• enhanced service navigation tools and access so that consumers and providers can find out what services are available
• using existing community structures to provide outreach services, so that consumers do not need to navigate the system. Colocation of services which provide a holistic view of needs, including social determinants
• changing funding models to those that encourage integration and collaboration. Look at opportunities for private funding and private sector support of programs.
• addressing the stigma around mental health, suicide and alcohol and other drug use. Recognise the different stigmas that exist and address the language used by media, communities and service providers.

A system where there is no wrong door to access

• better relationships and linkages between community-based services, government services, private sector and improved collaboration between mental health services and non-clinical services
• improved service navigation and data systems to enable sharing of both individual and service level data and information. Utilising peer workers to assist with navigation of the system
• development of flexible funding models which allow for engagement to be undertaken as part of the service delivery as well as enabling assertive follow up
• ‘No wrong door’ is a very negative statement and should be revised to a more positive term such as ‘a welcoming service’ or similar
• sharing of patient information needs to be easier and more consistent, but also driven by the consumer and their needs, not by the clinicians
• out of hours services need to be enhanced and developed, as to truly offer a ‘no wrong door’ service it needs to be available 24/7.

A system focused on outcomes, as defined by people’s own experience

• outcomes need to be consumer lead and defined, at all levels – individual, service, system and policy - ‘a system focused on a person’s goals, values and individual recovery plan’
• need to change the way in which data is collected and reported, currently driven by contractual performance indicators. This needs to shift to being outcomes focused
• need to use non-medical language, shift the focus from medical outcomes to social outcomes
• ‘outcomes’ does not capture the human and social elements of a person, need to consider these in evaluating services i.e. quality of life indicators
• move from a problem-focused to strengths-focused model.

A system that provides evidence – based service

• need to connect with universities and research institutes in a way that supports the meaningful transition of knowledge back to the sector. Bring evaluation and research expertise to the sector, to engage with research in the real world
• need to value and measure the engagement work that occurs in the sector. This work is integral to our work, but is often not valued and not measured. Need to also acknowledge that we work in a complex space, and often learnings occur in hindsight
• need to develop systems that support data collection and provide appropriate training to ensure service providers can use these tools
• need to use data collection tools that are mutually beneficial for both the person and the service
• funding models need to recognize the need for longitudinal evaluation and the current stop-start funding approach can affect our ability to gather evidence and data.

A system that builds the capacity of the workforce to support people and each other

• building the consumer and carer workforces and recognising the difference between consumers and carers. Involving consumers and carers in all aspects of the system and workforce
• workforce collaboration across sectors to promote collaboration and minimise competition Colocation of services and service models that encourage working with other professionals.
• ongoing professional development of the workforce including peer workers
• public mental health literacy and ensuring people have access to appropriate training and support. Incentivising mental health literacy across the community including in roles such as education, councils as well as community clubs and groups
• changing funding models to enable stability and consistency in service delivery. Fee for service models limit the capacity of the workforce to make systemic changes to improve patient care.

A system that drives health creation to keep people healthy in their communities

• social connection and self-determination is the foundation; therefore we need to apply our knowledge in new ways to create health creation systems, learning from the past and previous health promotion waves
• addressing stigma through education, normalise and de-medicalise mental health. Personal stories and impacts make stigma relatable. Look at ways to use current and emerging technologies and media
• need to recognise and address barriers to health promotion i.e. poverty etc. Taking a social approach to mental health and focusing on the social determinants to health to support consumers and communities.

Summary

Across each of the features there are common themes and needs that must be addressed to achieve an integrated and coordinated mental health, suicide prevention and alcohol and other drugs health system in our region. We will continue to work with the sector to understand these needs and identify the barriers to change which need to be addressed as we develop the regional plan.

The next steps of this process will be to release a discussion paper for consultation regarding the revised features of the system and key themes for change identified. We will also be undertaking consultation regarding the stepped care model and how this could work across our region.

Regular updates will be provided through our Recovery eNewsletter and the My Voice online engagement hub.

As well as the symposia, the PHN will be undertaking a variety of engagement activities focusing on particular streams of activity (e.g. children and young people, people with severe mental illness) over the coming months. These will be open to all and will feed into symposium two in June 2017.

You can comment or provide feedback on this article below, or if you would like further information or if you have any questions about this work please contact myvoice@brisbanenorthphn.org.au.